Monday, April 11, 2011

Pediatric Thyroid Cancer Post Operative Care

After thyroidectomy and/or neck resection to remove malignant thyroid tumors thyroid hormone replacement with levothyroxine is started in the first few days after total thyroidectomy. This replacement is withheld in patients who will receive radioactive iodine which is administered only to patients with extensive neck disease or distant metastases.
  • Cytomel or synthetic T3 is often used in place of levothyroxine prior to a postoperative nuclear scan or radioactive iodine (RAI) treatment. Cytomel has a shorter half-life, minimizing the period in which no suppression or replacement occurs and maximizing the uptake of radionuclide used in the scan or radioiodine therapy.  
  • Radioactive iodine (RAI) therapy should be administered to all children and young adults with cervical lymphadenopathy after a total thyroidectomy to reveal and treat all distant metastases in the lungs as mentioned above. 
  • A control thyroid scan is usually performed 2-3 weeks after surgery or radioiodine therapy. 
  • Thyroid carcinoma has been found to recur up to 33 years after treatment. TSH-suppressive doses (150-200 mcg/d of T4) are thought to decrease recurrence in differentiated carcinomas.
  • Patients should receive close follow-up care with pulmonary function tests, chest radiography, CT scans, and thyroid function tests. Thyroglobulin levels should be monitored for indications of medullary carcinoma.
  • Postoperative local external beam radiation is not recommended because of a possible carcinogenic effect in children.
  • Perioperative antibiotics are often used, and postoperative pain medications are standard, in addition to suppressive or replacement T4.

Author: Mark E Gerber, MD, FACS, FAAP  Clinical Assistant Professor of Otolaryngology, University of Chicago, Pritzker School of Medicine; Section Head, Pediatric Otolaryngology-Head and Neck Surgery, NorthShore University HealthSystem  

Co-Author: Brian Kip Reilly, MD  Assistant Professor of Otolaryngology and Pediatrics, Department of Otolaryngology, Children's National Medical Center, George Washington University School of Medicine  

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